Septumbased Medial Pedicle SMM

A 30-year-old patient who had 380 g and 420 g of gland resection from the right and left breast, respectively. The nipple was 35 cm preoperatively and elevated to 22 cm from the sternal notch. a Preoperative views. b, c Postoperative views Fig. 9.7 a-c. A 30-year-old patient who had 380 g and 420 g of gland resection from the right and left breast, respectively. The nipple was 35 cm preoperatively and elevated to 22 cm from the sternal notch. a Preoperative views. b, c...

Postoperative Care

A support garment is worn continuously for the first week to provide support and comfort. Drains are emptied three times a day and as needed. There is no need to change dressings as the opsite dressing is occlusive therefore, the patient can shower the day after surgery. At 7 to 10 days postoperatively, the patient is seen in the office, where dressings and steristrips are removed, exposed suture ends are clipped, and drains are removed. Scar treatment begins at this visit with a vitamin...

Owl Technique Breast Reduction

Arie G (1957) Una nueva tecnica de mastoplastia. Rev Iber Latino Am Cir Plast 3 28 2. Lassus C (1972) A new technique for breast reduction. Int Surg 53 69 3. Lejour M (1994) Vertical mammaplasty and liposuction of the breast. Plast Reconstr Surg 94 100 4. Hall-Findlay EJ (1999) A simplified vertical reduction mammaplasty shortening the learning curve. Plast Recon-str Surg 104 748 5. Hammond DC (1999) Short scar periareolar inferior pedicle reduction (SPAIR) mammaplasty. Plast Reconstr Surg 103...

Long Lasting Results of Vertical Mammaplasty

Ohe breast will feed the baby and will delight the father. This sentence from the Koran summarizes the two main functions of the breast Feeding It is obvious that any type of surgery on the breasts must protect those two functions. This is why, to me, safety is first shape is second in mammaplasty. Achieving beautiful and long-lasting results in a safe way is mandatory in breast reduction. Aubert, a French surgeon from Marseille, described in 1923 what is supposed to be the first tru...

Revisions Related to Skin Excess

Persistent skin excess, usually the most frequent complication, occurs at the inferior pole of the breast and is reported in approximately 10 of cases of vertical scar mammaplasty. It may be caused by various factors 1. Excessively high positioning of the pedicle, producing a dead space in the inferior pole and subsequent skin excess. 2. Insufficient excision of skin at the inferior end of the vertical incision (Figs. 14.2,14.3). It is absolutely essential to look for potential dog ears at this...

Infection Hematoma Seroma

Infections are rare and usually occur in the setting of necrotic tissue, which facilitates bacterial growth. Therefore, the application of techniques to avoid tissue necrosis will also reduce the incidence of infections. Hematomas are uncommon, and the risk can be diminished with meticulous hemostasis. Small hematomas may be evacuated through the wound without reoperation however, larger hematomas require reoperation with evacuation, hemostasis, and drainage. The frequency of seroma formation...

Liposuction for Final Tailoring

Prior to final skin closure, I perform liposuction not only along the lateral chest wall and in the preaxillary area, but also along the inframammary fold. I try to follow the Wise pattern for final parenchymal resection and remove the excess tissue just above the fold Fig. 7.8. This drawing shows the outline of the parenchymal re-section.Very little tissue is removed superiorly unless the patient has significant upper pole fullness preoperatively. The tissue resection follows a Wise pattern....

Discussion

After 10 years of performing inverted T,inferior pedicle breast reductions, I can say that I was not particularly unhappy with the procedure. In my hands, the pedicle was very reliable and I had had only one instance (in approximately 400 cases) of a partial nipple necrosis that healed completely without intervention. There were, however, some patients who had developed very unsightly scars in the inframammary fold. Of the three scars (around the areola, vertically down to the fold, and along...

Anatomy of the Breast A Clinical Application

Breast Anatomy

MoUSTAPHA HaMDI, ELISABETH WURINGER, InGRID SCHLENZ, RAFIC KUZBARI Ohe breast, by definition, is the soft protuberant body adhering to the thorax in females, in which the milk is secreted for the nourishment of infants or the seat of affection and emotions the repository of consciousness, designs and secrets The epidermis of the nipple and areola is highly pig-mented and somewhat wrinkled, and the skin of the nipple contains numerous sebaceous and apocrine sweat glands and relatively little...

The Operation

Immobilized Boob Size

The skin is deepithelialized within the markings (Figs. 11.1e, 11.6). A horizontal incision is made immediately below the areola and carried down to the muscular layer dividing the breast into two halves, superior and inferior (Figs. 11.1f, 11.7,11.8). The inferior half is freed from the skin with the use of a pair of scissors, leaving it attached to the muscle plane, while one is careful not to injure the fourth and fifth intercostal perforating vessels, which provide the nutrition for this...

Vertical Reduction Mammaplasty Using the Medial Pedicle

And make us lose the good we oft might win By fearing to attempt There are many approaches to breast reduction, and all have their advantages and their disadvantages the challenge is in achieving the ideal balance for each patient. I have found that the vertical approach using the medially based pedicle has given me improved results for the majority of my breast reduction patients 1-3 . Reducing volume is the object of the procedure,but maintaining blood supply to the nipple and breast skin,...

Preface

Aesthetic improvement and scar reduction has become the new front line in breast reduction surgery. It is probably easier to show surgeons who have spent many years honing their skills how to modify their own techniques to optimize scarring and achieve a better aesthetic outcome than to convince them to learn a new technique. I have tried in this book to assemble the techniques and thought processes involved in the evolution of the vertical scar mammaplasty over the last 10 years. It is a...

Skin Resection

Breast Reduction Immages

First a line is drawn from the midclavicle to the submammary sulcus passing through the nipple. At the projection of this line, a point is marked on the submammary fold. This point, A, corresponds to the new position of the nipple-areola complex. It can be placed lower in some cases when the breast tissue is firm and the surgeon notices that lifting the nipples will be difficult. Sometimes it is easier to elevate the nipple and areola several centimeters and sometimes even 2 cm is very...

Operative Design and Markings

Vertical Scar Technique Breast Reduction

There are numerous approaches to breast reduction surgery using a vertical skin resection pattern. Lassus 23-25 usually uses a superior pedicle and does not bevel his resection or undermine the skin. He resects the breast tissue directly down to the chest wall and does not resect the parenchyma along the Wise pattern. His inframammary fold stays in place. Marchac 26 uses a superior pedicle but adds a small horizontal scar or T to the bottom of the vertical incision. Lejour 27-30 uses a superior...

Superior Pedicle Vertical Scar Mammaplasty Surgical Technique

Vertical Mastopexy Technique

Man honours himself by not displaying all the knowledge he has acquired. I first tried the vertical reduction technique to minimize scars but have stayed with it because I saw improved results that hold up over time. It is my preferred method for breast reduction and mastopexy. Vertical scar techniques have not gained popularity in the United States as rapidly as in Europe and South America. The reluctance to abandon the Wise pattern in favor of the vertical reduction has been related to...

References

Lassus C (1970) A new technique for breast reduction. Int Surg 53 69 2. Lassus C (1986) An all season mammaplasty. Aesthetic Plast Surg 10 9 3. Lassus C (1987) Breast reduction evolution of a technique -a single vertical scar. Aesthetic Plast Surg 11 107 4. Lassus C (1996) A 30-year experience with vertical mammaplasty. Plast Reconstr Surg 97 373 5. Lejour M, Abbound M (1990) Vertical mammaplasty without inframammary scar with breast liposuction. Perspect Plast Surg 4 67 6. Lejour M (1994)...

Breast Reduction Scars

Breast Reduction Scars

Enlargement of the vertical and or areolar scar is present in 5 of patients. We believe this is due to technical reasons, either because of improper closure or because of inadequate compensation for the excess skin around the areola. The solution is simple revi Fig. 11.17. a-c Preoperative view of a young patient with hypertrophy and ptosis. d-f Postoperative view 17 months later. g Arms are elevated to allow visualization of the vertical scar, not extending beyond the submammary fold Fig....

Areas for Liposuction

Liposuction is performed not for volume reduction but for shaping. Any preaxillary fullness and any lateral chest wall fullness are marked. If one inframam-mary fold is higher than the other, then this fold is marked for more aggressive resection and liposuction along the inframammary fold. Fig. 7.4. The medial pedicle is a full-thickness pedicle carried down to the breast meridian. The base width measures about 6-10 cm (approximately a one-to-one ratio of length to base width). Although tissue...

Vertical Scar Mammaplasty with a Superior Pedicle

Ohe best of men is he who acquires learning but better than him is he who transmits it. in training who performed the operation in the university hospital. The same unfavorable results were published by Pickford 15 . Therefore, we tried to make the technique safer, keeping in mind the basic principles of the vertical scar mammaplasty. Operative Technique (Figs. 5.1-5.12) The goal of breast reduction is the correction of the volume, shape, and symmetry of the breast while preserving nipple...

Pedicle Choices in Breast Reduction

Wedge Biopsy Nipple Areolar Complex

Hall-Findlay y failing to prepare, you are preparing to fail. Surgeons should choose the right technique for the right patient. We plastic surgeons may be artists, but even artists still need to plan and to trace lines to create beautiful works. Breast reduction surgery usually combines a skin and parenchymal resection with a pedicle to maintain blood supply to the nipple-areola complex. This pedicle should allow adequate movement of the nipple to its new, more...

To the Nipple Areola Complex NAC

Stop Hypertrophic Scars Around Areola

The most serious complication of breast reduction surgery is nipple-areola complex (NAC) or breast necrosis. Very large breasts and or significant breast ptosis are the main reasons for such a disastrous complication, particularly in inexperienced hands. However, partial or total necrosis of the NAC can still occur in patients with high risk factors such as smoking, diabetes, or chronic corticosteroid therapy. Free nipple techniques in breast reduction are a viable alternative option for...

Short Scar Periareolar Inferior Pedicle Reduction Spair Mammaplasty

Horseshoe Shaped Vagina

Reast reduction offers an opportunity rarely seen in plastic surgery, for not only is there too much volume, there is too much skin. With a sound operative strategy, excellent technique, and a discerning artistic eye, the sculpting of an artistic and stable breast shape can occur every time, and now we can do it with half the scar What an exciting time to be a plastic surgeon. pattern technique have been thrown into sharper focus. Specifically, the inframammary scar can be problematic in some...

Underresection Pseudoptosis

Breast Pseudoptosis

This is the second most common reason for revision. I still have problems with underresection with this technique. I cannot get breasts as small with the vertical approach as I could with the inverted T, inferior pedicle approach. The technique itself does not allow as much resection, but the result at the end of the procedure can be misleading. The breast looks smaller than it is. If the plan is to remove about 700 g, then it is important to get as close to 700 g as possible. I will use...

Markings

Markings For Breast Reduction

The markings are made in the operating room after the patient falls asleep. The areola is marked using a 3.5-cm-diameter areola marker (Figs. 11.1a, 11.2). A line is drawn from the midclavicular point to the nipple -the meridian line of the breast. Point A is marked on the projection of the submammary fold on the previ- Fig. 11.1. a The new areola is outlined with a 3.5-cm diameter. b Points B and C are marked by pinching the skin at the level of the nipple and seeing the amount of resectable...

Revisions Related to Lateral Fullness

Patients with a high body mass index are at risk for developing this complication. Lateral fullness occurs more often in techniques in which a superolateral, lateral, or inferolateral pedicle is used. The fear of jeop- Fig. 14.8. A 28-year-old patient who underwent a breast reduction of 550 g on the right and 480 g on the left breast using the septum-based lateral mammaplasty Dr. Hamdi . A lateral fullness is seen because of insufficient resection on the lateral side of the left breast and...

Mastectomy Through a Vertical Incision

Breast Reduction Incisions

The standard modified radical mastectomy includes removal of the breast gland with the nipple-areola complex NAC as well as the skin overlying the tumor. However, more conservative techniques have been used if the tumor is not too close to the skin. Pe-riareolar incision is used widely nowadays to perform the mastectomy, which allows the removal of the gland with the NAC. Besides immediate reconstruction, excellent aesthetic results can be obtained. A vertical component can be added to the...